Surgical instrument



May 17, 1955 s, P. R. HUTCHINS SURGICAL INSTRUMENT 4 Sheets-Sheet 1Filed March 31, 1952 Je/wyn ER. Hutch/rm INVENTOR BY/ j wl/ A TTORNE Y6S. P. R. HUTCHINS SURGICAL INSTRUMENT May 17, 1955 4 Sheets-Sheet 2Filed March 31, 1952 y 7, 1955 s. P. R. HUTCHINS 2,708,437

SURGICAL INSTRUMENT Filed March 31, 1952.

4 Sheets-Sheet 3 Je/Wyr/ F. R. //u ch/rm IN V EN TOR.

sylg g Z W ATTORNEYS M y 7, 1955 s. P. R. HUTCHINS SURGICAL INSTRUMENT 4Sheets-Sheet 4 Filed March 31, 1952 SURGICAL IN STRUIVIENT Selwyn P. R.Hutchins, Houston, Tex., assignor to Elizabeth Painter Hutchins,Houston, Tex.

Application March 31, 1952, Serial No. 279,605 13 Claims. (Ci. 128-7)This invention relates to endoscopic surgical instruments used forexamination and surgery within cavities of the human body. While thepreferred form of the instrument described and shown in this applicationis designed primarily for transurethral prostatic surgery, it is readilyadaptable to other uses and is not limited to that specific purpose.

It is an object of this invention to provide an endoscopic surgicalinstrument of the cold punch type which provides a more positive cuttingaction and which is easier to employ than similar instruments now inuse.

Another object of this invention is to provide an instrument of thistype which will cut, as distinguished from shear, substantially all of atissue protruding through a fenestra in the instrument.

Another object is to provide an instrument of this type whereinresection of the desired tissue is effected by a rotating knife movingacross a fenestra through which said tissue protrudes, such resectionleaving an even bed of tissue facilitating more effective hemostasis andreducing the amount of prying to keep tissue engaged between thefenestra periphery and the knife.

Another object is to provide a surgical instrument of this type whichcan readily be manipulated with one hand leaving the other free, as forexample in prostatic surgery, for rectal palpation and third dimensionalperception.

Another object is to provide an improved instrument of this type whereinirrigating fluid is introduced close to the eyepiece in order to reducethe time for removal of bloody fluid from the region of the eyepieceafter draining the biadder or other body cavity of irrigating fiuid andresected tissue.

Another object is to provide an improved instrument of this type whichis adapted to be rotated so as to position the fenestra opposite anyselected portion of the lateral circumference of a passage into whichthe instrument is inserted, the instrument being so constructed andarranged to permit such rotation without necessitating a change in thestance or operating grasp of the doctor manipulating the instrument.

Another object of this invention is to provide an in strument of thistype so constructed and arranged as to permit rapid assembly anddisassembly for cleaning purposes or for interchange of parts and onewhich can be assembled without use of tools.

Other objects, advantages and features of this invention will beapparent to one skilled in the art upon the consideration of the writtenspecification, the appended claims, and the attached drawings wherein:

Fig. 1 is a general perspective view of a preferred embodiment of theinstrument of this invention showing it assembled;

Figs. 2 and 3 are isometric views, partially in section, illustratingthe mode of actuation of the cutting blade of this instrument;

Figs. 4 and 4a illustrate the positioning of the parts of the instrumentafter the blade has been retracted and just before a resection is made;

Figs. 5 and 5a are similar to Figs. 4 and 4a respectively except theyshow the cutting blade in the advanced position it occupies while anobservation is made therethrough;

23%,437 Patented May 17, 1955 Fig. 6 is a view taken on line 6-6 of Fig.5;

Fig. 7 is a view taken on line 7-7 of Fig. 5;

Fig. 8 is a view taken on line 3-8 of Fig. 5; and

Fig. 9 illustrates a type of wrench useful for changing the cuttingblade of the instrument of this invention.

Like characters of reference are used throughout the several views todesignate like parts.

A particular feature of this invention lies in the provision of aninstrument having an outer fenestrated tube in association with anannular knife which, in operation, has its cutting edge moved bothlongitudinally and laterally across the fenestra. To accomplish thispurpose, there is provided a novel means for moving the knife rotativelysimultaneous with longitudinal movement thereof. As an additionalfeature of this invention, an improved means is provided for supplyingirrigating fluid to the instrument so that such fluid will wash theinstrument free from bloody material tending to obstruct vision alongthe entire path of vision through the instrument.

Referring now to the drawings, the instrument comprises an outer tube 10having a smooth outer surface so that it is adapted to be inserted intothe body passage in which the resection is to be made. The outer tubehas a fenestra 11 situated near one end thereof. Disposed within passage12 in the outer tube and adjacent fenestra 11 is an annular knife 13having a circular cutting edge 14. Preferably, annular knife 13 is ofsuch outer diameter that it provides a snug fit in passage 12 andcutting edge 14 is disposed along the outer periphery of the knife sothat as the knife edge passes the fenestra, the tissue protruding intothe fenestra will be cut away even with the inner surface of passage 12.Knife 13 is carried at one end of an inner tube 15 and preferably has athreaded connection 16 therewith as illustrated in Fig. 9. Suchconnection permits rapid and easy changing of the knives on tube 15. Forthis purpose, as illustrated in Fig. 9, a short section of rubber tubing17 can be slid over the knife and grasped by a spring type Wrench 18having a semi-circular portion 19 and handles extending therefrompermitting the Wrench to tightly grasp rubber tube 17 and thereby turnthe knife from tube 15 without injury of the knife.

Outer tube 10 has a driving element 20 mounted for reciprocation withrespect thereto for a purpose to be made more apparent hereinafter.Driving element 20 can be mounted upon an annular tubular part 21 whichis connected to tube 10 by thread 22 and can be considered a part oftube 10. Tubular part 21 has a smooth surface portion 23 extending pastthread 22 toward tube 10 and having a close fit within the latter toincrease the rigidity of the connection between part 21 and tube 10.Tubular part 21 has an increased diameter portion 24 formed withlongitudinal grooves 25 and 26 adapted to slidably receive inturned keys27 and 28 carried by driving element 20. In this manner, there areprovided slide and guide parts between driving element 20 and tubularpart 21. Thence, upon longitudinal movement of driving element 20 withrespect to tube 10, the driving element is not permitted to rotate withrespect to the tube but can only move in a longitudinal direction.

An actuating means is provided for simultaneously rotating knife 13 andmoving it along fenestra 11 in a longitudinal direction. Such meansincludes not only driving element 20 but also a means connecting thiselement with the knife for translating movement of the driving elementinto simultaneous rotative and longitudinal movement of the knife. Suchconnecting means can comprise an elongate member 29 fixed with respectto inner tube 15 and having a spirally shaped portion such as spiralgrooves 30 disposed along its length. A pin member 31 is carried bytubular part 21, and hence by tube 10, in such a manner as to extendinto groove 30 and engage the same so that upon movement of tube andelongate member 29 past the pin in a longitudinal direction, tube 15 andknife 13 are rotated about their axes. To provide for longitudinaldriving of the tube 35 and knife 13, a driving bar 32 is carried by andas a part of driving element and has a connection with tube 15 to pullit forwardly with forward movement of the driving element. The drivingbar extends through tubular part 21 by means of slots 33 and 34. Itsconnection with tube 15 can comprise suitable anti-friction elementssuch as roller bearing assembly 35 abutting against elongate member 29.The normal functioning of this bearing assembly 35 is that the raceabutting the driving bar 32 receives driving force from the bar but doesnot rotate with respect thereto. The race abutting the elongate member29 normally rotates with the member 29, he balls of assembly 35 allowingsubstantially frictionless relative rotation between the bearing races.Means for biasing tube 15 and knife 13 in a direction away from fenestra11 can comprise a spring 36 having one end abutting suitableanti-friction elements such as roller bearing assembly 37 and the otherend abutting an inturned shoulder 35 on tubular part Zll. The rollerbearing assembly 37 normally functions in substantially the same manneras bearing assembly 35, the race abutting the elongate member 29rotating therewith and the race abutting the spring 36 remainingsubstantially fixed with respect to the spring 36 which normally doesnot rotate. An annular part 39 can be carried by tube 15 on the side ofdriving bar 32 opposite from elongate element 29 to permit tube 15 to bemanually retracted away from the fenestra should spring 36 fail tofunction as desired. Annular part 39 can be maintained in properrelationship with the driving bar by a small snap ring 39a situated ingroove 3%. It will be noted sufiicient space is left between annularpart 39 and driving bar 32 to permit the annular part to be slid towardthe driving bar for removal of the snap ring. It will also be noted thatannular part 39 has an endwise facing shoulder extending over the snapring and having a snug fit therewith to prevent dislocation of the snapring from its shallow groove upon the application of manual force to thedriving element to pull tube 15 away from the fenestra. In this manner,an easily removable, locked-in-place shoulder is provided on tube 15 forabutment with driving element 20 to retract knife 13.

With the apparatus as thus far described, it will be apparent thatspring 36 will bias knife 13 to one side of fenestra 11 as shown in Fig.4a when driving element 20 is released. However, upon movement ofdriving element 20 towards fenestra 11, driving bar 32 will engageroller bearing assembly 35 and urge tube 15 and knife 13 toward thefenestra. Simultaneously elongate element 29 will be rotated, therebycausing rotation of tube 15 and knife 13, by spiral groove 39 movingalong fixed pin 31. In this manner, knife 13 is moved longitudinallyacross fenestra 11 and simultaneously is rotated so that any tissueprotruding into tube It through the fenestra is actually cut, asdistinguished from sheared, by knife edge 14.

Tube 10 can be provided with a hand held in the form of an annularoutwardly extending flange 4t) and driving element 20 can be providedwith a similar flange 41 thereby permitting the surgeon to grasp theseflanges in one hand, if desired, and move driving element 21 withrespect to tube It). These flanges also permit the surgeon to readilyrotate the instrument without changing his stance or altering the mannerin which he grips the instrument.

An extension 42 of tube 19 is connected by means of thread 43 to tubularpart 21 to which it can be locked by screw 43a and has a passage 44extending therethrough into which tube 15 can be received andreciprocated. Extension 42 is provided with an internal endwise boss 45fitting snugly around tube 15 and having a packing cap 46 with a packing47 disposed therein adapted to form a seal with the outer periphery oftube 15. In this manner, a sliding seal is provided between extension 42and tube 15 permitting the passage of fluid from passage 44 andextension 42 through tube 15 and then on out through tube It}, or viceversa, as will be more fully described hereinafter. A spacer 46a isclamped between the end of part 21 and extension 42 and has outwardlyextending legs b adapted to prevent driving bar 32, part 39 or ring 39afrom striking cap 46.

An eyepiece 48 is connected to extension 42 by means of a bayonet jointincluding groove 49 in extension 42 and a pin 50 carried by theeyepiece. Eyepiece 48 has a passage 51 therethrough coinciding withpassage 44 and having its outer end closed off by suitable lens 52.Disposed immediately adjacent to and outwardly from the lens is anannular passage 53 having communication through inlet 54 with passage51. Inlet 54 is positioned so as to be in the upper portion of theeyepiece and passage 51 when the instrument is in its normal operatingposition. In this manner, any air which may be entrapped adjacent lens52 will flow out of passage 51 into annular passage 53 and be removedfrom the instrument thereby greatly facilitating the observation throughthe instrument.

Completing the endoscopic tube is an upturned portion 55 on the end oftube 10. Portion 55 contains a light source such as bulb 56 which isconnected to a source of el ctric current through post 57 and wires 58which, it will be understood, extend to the light bulb. In this manner,a surgeon can insert the instrument into a body cavity and then, afterturning on light bulb 56, observe the cavity by looking through lens 52down through passages 51, 54 and through tube 15 into passage 12. Itwill be noted that the end of tube 10 is mitered as at 59 to facilitateplacement of tissue for this observation.

Means are provided for introducing irrigating fluid into the instrumentin order to wash out bloody fluid or pieces of tissue from its interior.Such means can comprise a fluid inlet conduit 60 situated adjacenteyepiece 48 and between the eyepiece and the driving element so as tohave communication with passage 44 and tube 15. A major portion of fluidflowing inwardly through this inlet conduit will flow through tube 15and cut through passage 12 and a minor portion will pass in an oppositedirection through passage 51, inlet 54 and annular passage 53 to clearthe eyepiece of bloody fluid and the like. The fluid passing out of theeyepiece can be drained from annular passage 53 by a suitable iluidoutlet connection 61 having a valve 62 therein.

A fluid outlet is provided from the instrument to be employed to drainthe bladder and remove tissue pieces therefrom. Such outlet can comprisea fluid outlet conduit 63 having a valve 54 therein. The junctionbetween conduit 63 and extension 42 is enlarged by providing a slopingwall connection 65 on the side of the conduit adjacent the fenestra.With such construction, any tissue being removed through the instrumentwill not be likely to become lodged within the instrument since aconsiderably larger area is provided through which the tissue can fallinto conduit 63 than would be the case were wall 65 vertical.

To complete the instrument, a fulgurating electrode connection 66 isprovided permitting an electrode 67 to be pushed through passage 63 intube 10 and thence outwardly through mitered end 59 into contact withthe bed of raw tissue for facilitating hemostasis.

In the operation of this instrument, a fluid supply tube 69, containinga suitable flow control valve if demaking connection between a suitableelectric source and bulb 56, the instrument can be inserted into thebody passage where the resection is to be made, such insertion beingwith driving element 2% advancedto its Figs. 5-5A position. The tissuewhich it is desired to remove can be located by observing through lens52, passages 51 and 44, tube 15 and passage 12 to locate the tissueimmediately in front of tube at the miter-ed end thereof. After thetissue has been located and the instrument oriented both longitudinallyand rotatively, the instrir ment can be then advanced sufficientiy sothat the ob served tissue is positioned opposite fenesira 11 (the knifestill in its Figs. 5-5A position). Then, the surgeon permits spring 36to push element 29 and knife 14 to the Pigs. 4'4A position therebyopening the fenestra to permit tissue to protrude into it. After thetissue has been positioned within the fenestrn driving element 20 ispulled towards flange 4'3 and tube li causing driving bar 32 to movetube longitudinally while pin 31 coacts with elongate element 2? tocause simultaneous rotation of the tube. This simultaneous longitudinalmovement and rotation moves knife edge 14 of knife 13 longitudinallyalong fenestra 11 and rotates it thereby. As a result, substantially alltissue protruding into passage 12 through fenestra 11 is cut away andvery little if any will be pushed out of passage 1'2. through fenestra11 back into the bed of tissue being resected. This permits veryaccurate resections to be made, and it is ordinarily not necessary tooperate knife 13 several times in order to be sure to cut away all thetissue which originally extended through fenestra 11. When the tissuehas been severed, fluid flows through conduit 60, passage 44-, tube 15and out through passage 12 to remove any blood or tissue from withintube 15 and passage 12. Further observations can then be taken. After anew cut has been positioned opposite the fenestra as above described,release of driving element permits spring 36 to move the drivingelement, tube 15 and the connecting parts therebetween to the rear ofthe instrument.

After the resection has been completed, electrode 67 can be pushedthrough passage 68 and out into contact with the bed of cut tissueremaining in the body passage to provide an effective hemostasis in amanner well known to those skilled in the art.

From the foregoing it will be seen that this invention is one welladapted to retain all of the ends and objects hereinabove set forth,together with other advantages which are obvious and which are inherentto the structure.

It will be understood that certain features and subcornbinations are ofutility and may be employed Without reference to other features andsubcombinations. This is contemplated by and is within the scope of theclaims.

As many possible embodiments may be made of tlr: invention withoutdeparting from the scope thereof, it is to be understood that all matterherein set forth or shown in the accompanying drawings is to beinterpreted as illustrative and not in a limiting sense.

The invention having been described, what is claimed is:

1. In a surgical instrument, a tube having a lateral fenestra, anannular knife arranged for rotary and longitudinal movement within saidtube, and actuating means for simultaneously rotating said knife andmoving it longitudinally along said fenestra.

2. The instrument of claim 1 wherein said actuating means includes asecond tube disposed within the firstnamed tube, said knife beingcarried at the end of said second tube.

3. The instrument of claim 1 wherein said actuating means includes adriving element movable relative to said tube and means connecting saidelement with said knife and said tube with said knife for translatingmovement of said element with respect to said tube into 6 simultaneousrotative and longitudinal movement of said knife.

4. In a surgical instrument, a first tube having 3. lateral fenestra, asecond tube rotatable and reciprocal within said first tube, an annularknife carried by said second tube adjacent said fcnestra, a drivingelement mounted for longitudinal movement relative to said first tube,and means connecting said driving element, first tube, and second tubefor rotation and longitudinal movement of the second tube uponlongitudinal movement of the driving clement whereby said knife can berotated while moving longitudinally across said fenestra.

5. The instrument of claim 4 wherein said connecting means comprises anelongate member having a spirally shaped portion and a pin memberengaging said portion, said elongate member and said pin member beingcarried by said first and second tubes, and a connection between saiddriving element and said second tube limiting longitudinal movement butpermitting rotation therebetween.

6. The instrument of claim 4 in combination with means for introducingan irrigating fluid into said instrument for passage internally of saidfirst tube, and an eyepiece carried by an extension of said first tubeto permit observation through said second tube in the direction of saidfenestra, said means for introducing fluid comprising a fluid conduitadjacent said eyepiece and connected to introduce fluid into said secondtube and into said eyepiece.

7. The instrument of claim 5 in combination with means biasing saidsecond tube away from said fenestra to retract said knife after it hasbeen moved across said fenestra.

8. The instrument of claim 7 in combination with slide and guide partsconnecting said driving element and said first tube to prevent relativerotation therebetween.

9. In a surgical instrument, a first tube having :1 lateral fenestra, asecond tube arranged for rotary and longitudinal movement within saidfirst tube, an annular knife carried at the end of said second tubeadjacent said fenestra, a driving element reciprocal with respect tosaid first tube, an elongate member carried by said second tube andhaving a spirally arranged element thereon, a pin member carried by saidfirst tube and extending to engage said spiral element, a driving barconnecting between the driving elcrnent and said second tube to move thelatter longitudinally with the driving element and means biasing saidsecond tube away from said fenestra, whereby upon movement of saiddriving element toward said fenestra the second tube will simultaneouslyrotate and longitudinally move said knife across said fenestra.

10. The instrument of claim 9 in combination with slide and guide partsbetween the driving element and said first tube preventing relativerotation therebetween.

11. The instrument of claim 9 in combination with an eyepiece carried byan extension of said first tube to permit observation through saidsecond tube in the direction of said fencstra, and a fluid inlet conduitadjacent said eyepiece and connected to introduce fluid into said secondtube and into said eyepiece.

12. The instrument of claim 11 in combination with a fluid outletconduit adjacent said eyepiece and connected to receive flow from saidsecond tube.

13. The instrument of claim 12 wherein said eyepiece has an openingimmediately adjacent a lens in said eyepiece, said opening beingsituated in the upper portion of the eyepiece when the latter is in itsnormal operating position.

References (Iitcd in the file of this patent UNITED STATES PATENTS1,677,209 Rose July 17, 1928 2,279,714 Meyerhof Apr. 14, 1942 2,312,933Seiders Mar. 2, 1943 2,484,059 Wallace Oct. 11, 1949

